What might cause a terrifying moment in a man’s life? Getting caught having sex with another man’s wife or maybe getting a woman pregnant that he doesn’t love? Sure. But that leads us to the universal fear of every man: having an operation involving his testicles. Even the thought of a vasectomy makes men cringe and cross their legs.

A vasectomy is surgery involving cutting the vas deferens, the tubes that carry a man’s sperm from his scrotum to his urethra. It’s actually a very common procedure involving little risk. The urethra is the tube that carries both sperm and urine out of the penis. After a vasectomy, sperm cannot move out of the testes. After a man has had a successful vasectomy, he can no longer make a woman pregnant, but it is not a protection against sexually transmitted diseases (STD’s).

About half a million American men and as many as 30 million men worldwide each year choose vasectomy for permanent birth control. Most literature will say that a vasectomy is considered nearly 100 percent effective, simple, safe, fast (15-20 minutes), and avoids interference with sexual pleasure. Even young men are considering this easy operation as a form of birth control. Dr. Lipshultz says that the operation is reversible in 95% of cases where the man changes his mind within five years, but he doesn’t recommend vasectomy as a form of birth control. “When we see young, single guys, I make it clear to them that while they’re adults and can decide what they want to do with their own bodies, they have to realize this is not a temporary form of birth control. You have to consider it permanent.” Success rates for reversing a vasectomy drop as more time passes from the date of the original vasectomy. For those individuals who had a vasectomy over 15 years previously, the vasectomy reversal success rates fall to 71 percent.

Let’s take a serious look at this easy operation. Urologists and family practitioners can perform vasectomies. In the early 1970’s, Dr. Li Shunqiang of China developed a new procedure known as “No-Scalpel Vasectomy”. In the past few decades, over 15 million of these minimum-invasive procedures have been performed around the world. Doctors have usually taken additional training to perform the No-Scalpel Vasectomy and many believe it can minimize bruising, discomfort and promotes faster recovery time. Other physicians continue to use the standard operation. The basic steps of this No-Scalpel vasectomy are: The scrotal area is shaved and anesthesia is inserted through a tiny incision. A special clamp is used to pull the vas deferens to the surface of the skin. A slight pulling sensation will be felt. A segment of the vas is then removed and both ends are cauterized before the scrotum is resealed. After the vasectomy, it is said the discomfort is relatively mild…especially after a No-Scalpel vasectomy. Local anesthesia will begin to wear off an hour or so after the procedure. You will wear an athletic supporter or snug jockey shorts home, and for the following week. You should probably bring along a buddy or wife to drive you home, so you can rest…elevate your legs, stay off your feet, and use ice packs to soothe the scrotal area to help minimize swelling and discomfort. Resuming sex is usually off limits for 72 hours to a couple of weeks following surgery. You are not sterile for several weeks and it takes between 10 and 20 ejaculations before all remaining sperm is released, so it would be necessary to continue to use an alternate form of birth control. Sperm can remain in the semen from six weeks up to six months following your vasectomy, and you will need a semen analysis done in the lab before you’re considered sterile. Men usually will feel no change in their sexual drive after their recovery. A vasectomy doesn’t interfere with erections, and there are virtually no scars. After a vasectomy, the sperm normally produced are missing from the semen. Sperm are only a tiny portion of the ejaculation fluid (about 2 percent). The color and consistency of the ejaculate are not changed. The man’s body continues to produce testosterone as before and there is no effect on his masculinity. Testicles continue to manufacture sperm, but the sperm are now absorbed by the body.

Complications and Risks
Vasectomies are considered low-risk and complications are rare, but there are concerns. As with any surgery, there is the possibility of infection or swelling around the incision or inside the scrotum. A “blow out” involves the bursting of the severed vas deferens ducts because of pressure during ejaculation. It’s not life-threatening or serious, but very unpleasant and doesn’t feel good. When this rupturing occurs, sperm spills by the millions into the blood. The immune system goes into full alert and becomes “autoimmune”. Mistakenly, the sperm become a threat to your body and then the body attacks its own cells. Research has shown that the higher the sperm count a man has, pre-vasectomy, the higher a chance he will become autoimmune after surgery. This response has been linked to certain diseases including testicular dysfunction, hormonal imbalances, recurrent infections, and while it is unproven, some think this is a main cause for prostate cancer. According to Dr. H. J. Roberts, an internist who has studied the effects of vasectomy on the immune system for over 30 years, “No other operation performed on humans even approaches the degree and duration of the multiple immunologic responses that occur in the post-vasectomy state.” The appearance of symptoms from these reactions may take years to manifest. Another vasectomy complication is chronic pain in the scrotal region. Surveys asking patients about their pain claim that up to one-third of men receiving vasectomies complained about this pain known as chronic Post-Vasectomy Testicular Pain. Urologists can tend to down-play this because it would unnecessarily traumatize the patient. Read the literature about it and decide for yourself. If the pain is severe, further surgery may be recommended, and sometimes it works and sometimes it doesn’t. Men, not liking to complain, (especially about their genitals), usually suffer alone when nothing is done to improve the situation. Kevin Hauber wrote a book entitled, “If It Works, Don’t Fix It: What Every Man Should Know Before Having A Vasectomy”. It might be a worthwhile read, before and even after a vasectomy, if problems are occurring.

Reversal
The worst complication or side effect, if you can call it a side effect, is that a vasectomy might not be reversible. This is why men should be very careful before they undertake this procedure. Vasectomy Reversal is performed on as many as 30,000 to 50,000 men each year. Life can present many changes that might alter one’s outlook and precipitate the desire for reversal, including the death of a child, remarriage, or just the spontaneous wish to have more children. Then it would be time to find a highly-recommended doctor to try to do the vasectomy reversal. The surgery requires using micro-surgery, meaning the surgeon uses special microscopes to reconnect the tiny tubes of the vas deferens. Today, with high-technology equipment, doctors can do the procedure that ten to fifteen years ago seemed unthinkable. The best chance for a successful reversal involves the surgeon’s skill, the time passed from the date of the vasectomy (usually about 6 years), and the age of the man (with the ideal age being between 40-45 years old). If the time passed is 7 years or more, the success rate drops from 97 percent to 79 percent.

Cost of vasectomy reversal can range from $6,000 to $15,000. Check with your insurance company, because most do not cover this procedure. Postoperative pain is comparable to what you experienced after your vasectomy, but the recovery time is longer and your hospital stay might involve two or three days. The scrotum may double in size due to bruising, but gradually goes back to normal within one week. Pain pills are usually given the first few days and you should get proper rest and refrain from physical activity. Most doctors require that you must wait 4 weeks to have sex or attempt to ejaculate. Semen is commonly seen after five or six weeks. If sperm is not found after a maximum of six months, then it would be considered that the reverse vasectomy was a failure.

ADVICE
● Vasectomies should be considered permanent birth control, so carefully weigh your decision based on your age, financial and marital situation.
● Vasectomy is generally not recommended for couples under age 25.
● If you think you might have a change of heart, it may be better to use other methods of birth control until you are confident of your decision.
● Be informed and discuss all your options with your spouse and your physician.
● Sterility is not immediate following a vasectomy. (It will take 10-20 ejaculations or more and several weeks before your reproductive system is free of active sperm).
● A vasectomy is not a protection against sexually transmitted disease (STD). (You will still need the protection of a condom or other means of protection).
● Rest is advised for a few days; return to work is typically three days.

Complications and Risks
● Pain or discomfort following surgery
● Itching due to an allergic reaction to local anesthetic
● Penis and scrotum might appear bruised
● Sperm can leak from the vas and cause a small lump
● The large tube connected to the vas can become inflamed
● The immune system may produce antibodies to attack sperm
● The cut vas deferens spontaneously rejoin (only 1 in 10,000 chance)

Vasectomy—a brief history
In the U.K., way back in 1830, Sir Ashley Cooper performed a vasectomy on a dog and observed that the dog was able to have sex, yet unable to get other dogs pregnant. Research found that though the exit of the sperm was shut off, the sperm continued to be produced by the testicles until the dog died 6 years later. Such well-known people as Freud and W.B. Yates had vasectomies, believing that it increased testosterone, and would therefore increase their sex drive. Vasectomy was also used to control population by sterilizing criminals, drug addicts and misfits the authorities didn’t like. It has been used as a cure for enlarged prostate, and it was in the early 1960’s that it became used by the masses in the U.S. as a method
of birth control.

Sterilization for a woman is a more significant operation that is more difficult for the woman than a vasectomy is for a man. Vasectomies on men are faster, easier and less expensive than tubal ligation for women, and vasectomies are done with a local anesthetic.

Tubal ligation is popular and available around the world, although some Muslim countries do not permit it. Worldwide, female sterilization is used by 33% of married women, and over 10 million women in the United States have had the procedure. Women less than 30 years of age and with no children are often denied this procedure.

Temporary birth control such as birth control pills, the patch, the ring, and some IUD’s, contain hormones and can sometimes interfere with your monthly cycle. The typical tubal ligation is performed on women over 30 years old, married, and with two to three children. With tubal ligation, known as getting your “tubes tied”, a woman needs general anesthesia, requires a longer recovery period, and the operation is more expensive. It is also more invasive, can result in greater discomfort, and comes with higher risks than a vasectomy procedure.

Usually performed as a laparoscopic procedure, the fallopian tubes are blocked by either clamping with metal clips or plastic rings, cutting away a section of the tube, or burning a portion of the tube. The clamps, rings, or clips remain in the body and then stitches are used to close the cuts. This procedure takes about 45 minutes and recovery is about 4-6 days. There will probably be cramping, discharge and some pain and bruising at the wound. Feeling tired and achy and having a bloated abdomen seem to be par-for-the-course.

In 2002, another form of permanent sterilization started being performed called Essure. Unlike tubal ligation, this can be performed in a doctor’s office, and because there is no cutting, there is no need for general anesthesia. The Essure procedure involves inserting a soft, flexible micro-insert into the vagina through the cervix and into the uterus – placing metal coils into the fallopian tubes. The micro-inserts are made from polyester fibers and metals (nickel-titanium and stainless steel). Usually within 3 months, tissue grows into the insert and forms a natural barrier preventing the sperm from reaching the egg. The Essure procedure takes about 5-10 minutes, and 45 minutes later you can leave the doctor’s office. This procedure is considered permanent and cannot be reversed. Confirmation that the procedure worked requires at least one uterine dye x-ray procedure. Reliability of effectiveness is 98-99% for both Essure and tubal ligation. Most insurance providers will cover the Essure procedure, and because it’s performed in a doctor’s office, your payment may be as low as a simple co-pay. This will all depend on your insurance plan.
Tubal reversal, if done by a microsurgeon specialist, has a high success rate and few complications. Successful repair of the fallopian tubes is now possible in 98% of women who have had a tubal ligation, regardless of the type of sterilization procedure.

As with all procedures, there are risks involved, so try and read as much as you can about either tubal ligation or Essure before going ahead with it. Post tubal ligation syndrome (PTLS) is a term used to describe a variety of side effects or symptoms. Included are: heavier menstrual bleeding and cramps, as well as other symptoms attributed to changes in hormone levels. One possible suggested cause of these symptoms is disruption of the normal blood between the fallopian tubes, ovaries, and uterus.

Tubal Ligation RISKS & FACTS

● Dizziness
● Abdominal Pain
● Gassy or bloated feeling
● Sore throat
● Nausea
● Changes in bowel movements
● Hormone production, libido, and the menstrual cycle can be affected by a tubal ligation
● Bleeding
● Bowel injuries

Essure RISKS & FACTS

● Should be considered irreversible
● Another form of birth control MUST be used for 3 months after the procedure
● Mild to moderate pain or cramping (with a possibility of never going away)
● A small chance of tubal perforation during the placement of the Essure micro-inserts
● Bleeding or spotting
● Possible increased risk of ectopic pregnancy, a condition in which the fertilized egg implants in a place other than the uterus,
usually in one of the fallopian tubes
● Nausea
● Coils can sometimes fall out
● Because of the metal coils, MRI’s cannot be used on the midsection area. SLV

Issue 45 featuring: Capri Anderson, Felix Vicious & Jayme Langford and Jenna Haze